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Cogwheel rigidity, a cardinal sign of Parkinson’s disease, is marked by muscle rigidity that reacts with superimposed ratchetlike movements when the muscle is passively stretched. This sign can be elicited by stabilizing the patient’s forearm and then moving his wrist through the range of motion. (Cogwheel rigidity usually appears in the arms but can sometimes be elicited in the ankle.) Both the patient and the examiner can see and feel these characteristic movements, thought to be a combination of rigidity and tremor.
After you’ve elicited cogwheel rigidity, take the patient’s history to determine when he first noticed associated signs of Parkinson’s disease. For example, has he experienced tremors? Did he notice tremors of his hands first? Does he have “pill-rolling” hand movements? When did he first notice that his movements were becoming slower? How long has he been experiencing stiffness in his arms and legs? Has his handwriting gotten smaller? While taking the history, observe the patient for signs of pronounced parkinsonism, such as drooling, masklike facies, dysphagia, monotone speech, and altered gait.
Find out which medications the patient is taking and ask if they’ve helped relieve some of his symptoms. If he’s taking levodopa and his symptoms have worsened, find out if he has exceeded the prescribed dosage. If you suspect an overdose, withhold the drug. If the patient has been taking a phenothiazine or another antipsychotic and has no history of Parkinson’s disease, he may be having an adverse reaction. Withhold the drug as appropriate.
In this disorder, cogwheel rigidity occurs together with an insidious tremor, which usually begins in the fingers (unilateral pill-roll tremor), increases during stress or anxiety, and decreases with purposeful movement and sleep.
Bradykinesia (slowness of voluntary movements and speech) also occurs. The patient walks with short, shuffling steps; his gait lacks normal parallel motion and may be retropulsive or propulsive. He has a monotonal way of speaking and a masklike facial expression. He may also experience drooling, dysphagia, dysarthria, and loss of posture control, causing him to walk with his body bent forward. An oculogyric crisis (eyes fixed upward and involuntary tonic movements) or blepharospasm (complete eyelid closure) may also occur.
Phenothiazines and other antipsychotics (such as haloperidol, thiothixene, and loxapine) can cause cogwheel rigidity. Metoclopramide causes it infrequently.
If the patient has associated muscular dysfunction, assist him with ambulation, feeding, and other activities of daily living, as needed. Provide symptomatic care as appropriate. For example, if the patient develops constipation, administer a stool softener; if he experiences dysphagia, offer a soft diet with frequent small feedings. Refer the patient to the National Parkinson Foundation or the American Parkinson Disease Association, both of which provide educational materials and support.
Cogwheel rigidity doesn’t occur in children.
Read excerpts from these other book chapters related to Stiff neck:
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
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